??????? ???????S???O? ??S????????O? ????O??O? G??p? (??f?????tsa)

1
??????? ???????S???O? ??S????????O?
????O??O?G??p? (??f?????tsa)
???????? ???????? ???G??? ????O??O? 5?
???S???????? ??????? ??e???? ??s???µe?a???
???µ??e??

• ?a??a ?????????
• ?a??????? ???µ?????????
• G.?.?. ?pp????te??
• ???µß???? 20005

2
??t?e? ?a??t?? pa???sµ??? (pe???aµßa??µ???? t??
a?apt?ss?µe??? ?????)
3
(No Transcript)
4
G??p? ?st????? st???e?a

• ?e????af? t?? p??t?? pa?d?µ?a? ??e?a?
  a?ap?e?st???? ??s?? t? 1580 µ.?.
• ??t?te 31 pa?d?µ?e?
• ? µe?a??te?? pa?d?µ?a t? 1918-1919 (?spa????
  ???p?) µe 21.000.000 ?a??t??? pa???sµ???
• ?p?µ???s? t?? ??? ???p?? ? se ?????ß?a t? 1933
• ?a??????e?a ??? se a??? ???a? t? 1936
• ???state?t??? d??s? t?? eµß????? st?? de?aet?a
  t?? 40
• ?????aµµa ?e????? eµß???asµ?? st?? ??? t? 1976
• ?????s? aµa?tad???? ??a ???p? ? sta µ?sa
  de?aet?a? t?? 60
• ?????s? ??µa?tad???? ??a ???p? ? t? 1993
• ?????s? ?a?aµ?ß???? ?a? ?se?taµ?ß???? ??a ???p? ?
  ?a? ? t? 2000

5

• ?spa???? ???p?, 1918-1919 Camp Funston, Kansas,
  ???

6
G??p?

• ??e?? t?p?? ??? ???p?? A, B C
• ??? ???p?? ? ???sß???e? t?? ?????p?, pt???,
  ???????, ????a, f???e?, f??a??e?, ??p.
• ??a????eta? se ?p?t?p??? a?????a µe ta µ???a
  a?µa????t?????? (H) ?a? ?e??aµ???d?s?? (?) p??
  ??e? st?? ep?f??e?? t??.
• ??µa????t????? 15 ?p?t?p??, ?e??aµ???d?s? 9
  ?p?t?p??
• ?a??????? ?p?t?p?? ??? ???p?? ??a t?? ?????p?
  ?1?1, ?1?2 ?a? ?3?2
• ??? ???p?? ? ???sß???e? µ??? t?? ?????p?, de?
  ?p?????? ?p?t?p?? ?a? p???a?e? µ??? ep?d?µ?e? ?a?
  ??? pa?d?µ?e?.
• ??? ???p?? C ????a?e? ?p?a ??s? st?? ?????p? ?a?
  de? p???a?e? p?t? ep?d?µ?e? ? pa?d?µ?e?.

7
??µ? t?? ??? ???µat?????a
8
? d?µ??????a ???? ?p?t?p?? ??? ???p?? ??t????????
?e?te??sµ?? (antigenic shift)

• ?a??de??µa
• ??? de?aet?a 1957-1967 ß??s??ta? se ?????f???a
  ??? H2N2
• ?? 1968 eµfa??st??e ??? H3N2 ?a? a?t??at?st?se
  p????? t?? p??????µe??

9
(No Transcript)
10
??t?????? ???s??s?Antigenic drift t?? ??? ???p??

• ?a??de??µa
• ?? 1997 t? ????a??? st??e??? ?ta? t?
  A/Wuhan/359/95 (H3N2)
• Sta t??? t?? 1997 eµfa??st??e t? st??e???
  A/Sydney/5/97 (H3N2) ?a? t? 1998 ????e ????a???
  st??e???

11
????ap?as?asµ?? t?? ??? ???p??

• ???s?????s? ?a? d?e?sd?s? sta ep?????a?? ??tta?a
  t?? a?ap?e?st????
• ??a??p? t?? pa?a????? p??te???? ap? ta ??tta?a
  p??? ?fe??? t?? pa?a????? ????? s?µat?d???
• ??tta????? ???at??

12
???p?? µet?d?s?? t?? ?????? a?ap?e?st????
pa???????Musher D.M., N Engl J Med
20033481256-66
????????a??sµ?? ?µes? epaf? ????? ?a? µesa?a sta????d?a ???? µ???? sta????d?a (p????e?)
N. meningitidis ??? ??? ???
S. pyogenes ??? ??? ???
S. pneumoniae ??? ??? ???
M. tuberculosis ??? ??? ???
??? ???p?? ??? ??? ???
?de????? ??? ??? ???
RSV ??? ??? ???
??????? ??? ??? ???
13
???????? e?d???se?? ???p??

• ?????? ep?as?? 2 ?µ??e? (1-4)
• ? ßa??t?ta t?? s?µpt?µ?t?? e?a?t?ta? ap?
  p??????µe?? ???es? se s???e?? ??
• ??s?st? p??sß???? (attack rate) se pe???d???
  ep?d?µ??? µ???? ?a? 40
• ?s?µpt?µat??? ??s?? st? 50
• ??ass??? ???p? a?f??d?a ??a??? p??et??
  (38-400C), µ?a?????, fa????a???a? ?a? ????? ß??a
  p?? s???de???ta? ap? ??t??? ?ataß???
• S???d? s?µpt?µata ????????a, ?efa?a???a,
  ?p?s??ste????? ?a?st??? ?????, ?p?s??ß??ß????
  p???? ?a? f?t?f?ß?a
• ?????e?a s?µpt?µ?t?? 2-3 ?µ??e?
• ???s??? s??d??µ? Reye µet? ap? ???? asp??????

14
?p?p????? ???p??

• ?? ep?p????? t?? ???p?? e??a?
• ??e?µ???a
• ?e?te??pa??? (µ????ß?a??) p?e?µ???a
• S. pneumoniae
• H. influenzae
• S. aureus
• ???t?pa??? (???e???) p?e?µ???a (p??? s?ßa??)
• S??d??µ? Reye (se pa?d?? p?? ??aßa? asp?????)
• ?p?µ???? ?µet??, s????s?, ??µa ap? e??efa????
  ??d?µa
• ????a?d?t?da
• ???s?t?da
• ?a?????s? ?????a? ß?????t?da?
• T??at?? (0.5-1.0 a?? 1000 pe??pt?se??)

15
?? ep?pt?se?? t?? ???p??

• 36.000 ep? p???? ???at?? et?s??? st?? ???
• gt90 t?? ?a??t?? se as?e?e?? ?????a? gt65 et??
• ?e?a??te?? ???s?µ?t?ta se pe???d??? ?????f???a?
  ??? ???p?? ? (H3N2)
• ????? p?s?st? ep?p????? ?a? ??s??e?a? se pa?d??
  ?a? ??????µ?????
• gt120.000 ??s??e?e? et?s??? st?? ???
• S????t?ta ??s??e?a? sta pa?d?? 0-4 et?? 100-500
  a?? 100.000 pa?d??
• ?e?a??te?? s????t?ta ??s??e??? se pe???d???
  ?????f???a? ??? ???p?? ? (H3N2)

16
T??s?µ?t?ta ap? ???p? ?a? p?e?µ???a st?? ???
17
? d?????s? t?? ???p??

• ??????? ?a? ep?d?µ???????? ?a?a?t???st???
• ?p?µ???s? t?? ??? ap? ß???????? ?????
  (????fa??????? ??p??µa, fa??????? ep????sµa,
  pt?e?a)
• ????s? t?t??? a?t?s?µ?t?? IgG µe CF ? HI
• a????? de??µa µ?sa st?? p??te? 5 ?µ??e?
• de??µa a?????s?? se 21 ?µ??e?
• ?µes? a????e?s? a?t?????? ???

18
?µes? a????e?s? a?t?????? ??? ???p??
??a?s??s?a 70 ??d???t?ta 90
19
?µß???? ??a?t? ???p??

• ?d?a??p???µ???? ??? ? tµ?µata ??? (split) ???p??
  ? ?
• ???d??aµ? µe et?s?a d?af???p???s? a?????a µe
  ?????f?????ta ste????
• ?p?te?esµat???t?ta 60-80 (a?????? t??
  s?µf???a?)
• ?e???d?? eµß???asµ?? (???) ??t?ß???? - µ?sa
  ??eµß????
• ?a?e????e?e? 5-8 t?p??? e?a?s??s?a ?a? ?aµ????
  p??et??
• ??te?de??e?? ?st????? ?pe?e?a?s??s?a? ?µes??
  t?p?? st? eµß???? ?a? ?pe?e?a?s??s?a
  a?af??a?t???? t?p?? st? a???
• Preservative-free eµß???a ?a? t? p??ß??µa t??
  ?e??µe?s???? (?d????????)

20
?p?te?esµat???t?ta eµß????? ??a?t? ???p??

• ??a?t?ta? ap? t?? s?µf???a t?? ?????f?????t??
  ste?e??? µe a?t? p?? pe???aµß??e? t? eµß????
• 60-90 p?????? t?? epe?s?d??? s?µpt?µat????
  ???p?d??? s??d??µ?? se ?t?µa lt65 et??
• 30-40 ap?te?esµat???t?ta se ??????µ?????
  as?e?e??
• 50-60 p?????? e?sa????? se ??s???µe?a
• ??????? ?a?at?f???? ep?p????? ?at? 80
• ?????e?a p??stas?a? 2-6 µ??e?

21
?µß???? ??a?t? ???p?? (???)

• ?? 2003 ?????f??e? st?? ??? eµß???? µe ???te?
  ????
• ??????s? ?p? µ??f? spray ap? t? µ?t? (FluMist)
• ???d??aµ? µe et?s?a d?af???p???s? a?????a µe ta
  ?????f?????ta ste????
• ?e? pe????e? ?e??µe?s??? ? ???a s??t???t???
• ?et? t?? eµß???asµ? ? ??? d?aspe??eta? ??a
  a??et?? ?µ??e?
• ?p?te?esµat???t?ta 87 sta pa?d??
• ??????? µ?s?? ?t?t?da? ?at? 30
• Se e?????e? µe??s? t?? eµp???t?? epe?s?d??? ?at?
  25-40
• S?s??t?s? µe pe??pt?se?? pa????s?? Bell (?)

22
??de??e?? eµß???asµ?? ??a?t? ???p??eµß????
2005-6 (A/California/7/2004(H3N2)-A/New
Cal(H1N1)-B/Shanghai/361/2002) Advisory
Committee on Immunization Practices, 2005

• ?t?µa p?? ß??s???ta? se ???d??? ?a ??s?s??? ap?
  ???p?
• ?t?µa ?????a? gt64 et??
• ???f?µ?? ??????µe???, ??p
• ???a??µe??? se ?????? pa????? ??e?a? (st???? 50
  t?? p??s?p????)
• ??????e? ?a? pa?d?? µe ?????e? p?e?µ??????,
  ?a?d?a??? pa??se?? ?a? ?e?????????? pa??se??
• ??????e? ?a? pa?d?? µe ?????e? µetaß??????
  pa??se??, ?ef???? a?ep???e?a, a?µ?sfa?????p??e?e?
  ? a??s??atast??? (pe???aµß??eta? ?a? ?
  HIV-???µ???)
• ?a?d?? (6 µ???? - 18 et??) p?? ?aµß????? ?e?ape?a
  µe asp????? ??????? (???d???? ??a s??d??µ? Reye)
• G??a??e? p?? ?a ß??s???ta? st? 2? ? 3? t??µ???
  t?? ???s?? ?at? t?? d????e?a t?? ep???a???
  ??a?s?? t?? ???pp??
• ?a?d?? 6-23 µ????

23
?a?e????e?e? eµß????? ???p??

• ??p??? ????? st? s?µe?? t?? ??es?? (10-64)
• ???et??, ?a?????a, µ?a???e? ??a 1-2 ?µ??e?
  (5-10)
• ???e????? a?t?d?as? ?µes?? t?p?? (a?af??a?t???)
  p??? sp???a
• S??d??µ? Guillain-Barre µ???? t? 1994
  11.000.000 d?se??, µet? t? 1994 ap??sd????st?
  s????t?ta
• ?e??s? t?? s????t?ta? ?at? 75 µeta?? 1993-1994
  ?a? 2002-2003 (JAMA 20042922478)
• S?µpt?µata ???µ???? a??te??? a?ap?e?st???? µet?
  t? FluMist
• ?a????s? p??s?p???? t?p?? Bell µe t? FluMist

24
?µß???asµ?? ??a?t? t?? p?e?µ??????????

• ??e?µ??????????? p?e?µ???as?ßa?? ep?p???? t??
  ???p??
• ?µß???asµ?? e?pa??? ?µ?d?? ?a e?att?se? s?µa?t???
  t?? s????t?ta
• ??????e? ?µß???? p???sa??a??d??? 23d??aµ?.
  ???stas?a 80 ??a 5 ?t?
• ?a?d?? lt5 et?? ?µß???? s??e??µ??? 7d??aµ?.
  ?a????????a a??s?a
• ????????S???????S???
• ?t?µagt65 et??
• ?a?d?? lt2 et??
• ??????e? ?a? pa?d?? µe ?????a ??s?µata ?p??
  p?e?µ?????? ?a? ?a?d?a??e?a??? pa??se??, HIV,
  asp????a, d?epa????tta???? a?a?µ?a
• ?s?e?e?? µe d?aß?t?, a??????sµ?, ?????s? ?pat??

25
?a???sµ?a ?ata????s? eµß????? ???p??, 2000
26
Te?ape?a t?? ???p??
27
Te?ape?a t?? ???p?? (3)
28
??de??e?? p??f??a?t???? ?e?ape?a? t?? ???p??Wood
A.J.J., N Engl J Med 20003431778

• ?t?µa ?????? ???d???? p?? de? eµß????s???a?
• ?t?µa ?????? ???d???? p?? ??aßa? t? eµß????
  ?a??ste??µ??a
• ?t?µa ?????? ???d???? p?? ??aßa? eµß???asµ? a???
  ?p???e? as?µf???a eµß????? µe ta ?????f?????ta
  ste????
• ?t?µa µe a??s?a?ep???e?a
• ?? eµß???as???ta ?t?µa p?? f???t?????
  ??????µ????? ? ?t?µa ?????? ???d????
• ???? ?? e??a??µe??? µ?sa se ?d??µata ??????µ????
  ? ??????? pas???t??, ?at? t?? d????e?a ep?d?µ???
• ?µß???as???ta ?t?µa ?????? ???d???? ??a µ???st?
  p??f??a??

29
? ???p? t?? p???e?????

• ?a pt??? p??sß?????ta? µ??? ap? t?? t?p? ? ???
  ???p??.
• ?a µ? ?at????d?a pt??? ap?te???? t?? f?s???
  de?aµe?? t?? ??? ?a? de? ??s??? (p? a????p?p?e?)
• ?a ?at????d?a pt??? (??t?p???a, ?a??p???e?) e??a?
  d??at?? ?a ??s?s??? ßa??? ?a? pe?a?????.
• ?? ?p?t?p?? ?5 ?a? ?7 d?a??????ta? pe?a?t??? se
  ???? ?????? ?a? ?aµ???? ??s?????? d??s?? (HPAI
  ?a? LPAI).
• ?? ??? HPAI µp????? ?a p???a??s??? ???t?t?ta sta
  pt??? µ???? ?a? 100.
• ?? ??? LPAI µp??e? ?a µetat?ap??? se HPAI ?at?
  t?? d????e?a µ?a? ep?d?µ?a?.
• ???sß???eta? ? ?????p??
• ?etad?deta? ? ???p? t?? p???e????? ap? ?????p? se
  ?????p?

30
? ???p? t?? p???e????? H5N1 st?? ?????p?
???a ?e??pt?se?? ???p?? H5N1 T??at?? T??s?µ?t?ta (Case fatality rate)
Thailand Vietnam Cambodia Indonesia S????? 20 92 4 9 125 13 42 4 5 64 70 45 100 75 51
WHO data, Nov 9, 2005
31
(No Transcript)
32
?????ep?d?µ?e? µe d??at?t?ta pa?d?µ?a? (1968-2003)

• 1976 G??p? t?? ?????? (?1?1) st?? ???
• 1986 G??p? t?? ?????? (?1?1)
• 1988 G??p? t?? ?????? (?1?1) st?? ??? 1
  ???at??
• 1993 G??p? t?? ?????? (?3?2) st?? ???a?d?a
• 1995 G??p? t?? p???e????? (?7?7) st? ?. ?as??e??
• 1997 G??p? t?? p???e????? (?5?1) st? Hong Kong
  6 ???at??
• 1999 G??p? t?? ??t????? (?9?2)
• 2003 G??p? t?? p???e????? (?5?1) st? Hong Kong
  1 ???at??
• 2003 G??p? t?? p???e????? (?7?7) st?? ???a?d?a
• 2003 G??p? t?? p???e????? (?5?1) st? Guangdong,
  ???a
• 2004 G??p? t?? p???e????? (?5?1) st? ??et??µ

33
Pandemic Influenza
The influenza pandemic of 1918-19 killed more
humans than any other disease in a period of
similar duration in the history of the
world. Alfred W. Crosby Americas
Forgotten Pandemic The Influenza of
1918 Cambridge University Press, 1989
34
2003-4 Outbreak of Highly Pathogenic Avian (HPAI)
Influenza A (H5N1) in Asia
W.H.O. Official Says Deadly Pandemic Is Likely if
the Asian Bird Flu Spreads Among People By KEITH
BRADSHER and LAWRENCE K. ALTMAN HONG KONG, Nov.
29 - A pandemic of human influenza could kill up
to 100 million people around the world in a worst
case, a World Health Organization official said
Monday, significantly raising the agency's
earlier estimates of the potential number of
deaths in such a catastrophe.
35
Pandemic Influenza Outbreak of Avian Influenza A
(H5N1) in Asia
36
Pandemic Influenza Outbreak of Avian Influenza A
(H5N1) in Asia
37
Phases of an Influenza Pandemic
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity.
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable.
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
38
Phases of an Influenza Pandemic
39
Trends in Infectious Disease Mortality in the
United States During the 20th Century
Armstrong, GL. JAMA. 1999 Jan 6281(1)61-6.
40
Pandemic Influenza 1918 Influenza Pandemic

• 20-40 million persons died worldwide, possibly
  more
• Death rate 25 times higher than previous
  epidemics
• 500-650,000 deaths in the U.S. Ten times as many
  Americans died of flu than died in WW I
• The epidemic preferentially affected and killed
  younger, healthy persons
• The epidemic was so severe that the average life
  span in the U.S. was depressed by 10 years

41
Pandemic Influenza Potential Impact of Pandemic
Influenza in the U.S.

• Cannot predict the severity or exact onset of a
  pandemic
• Up to 200 million persons infected
• 38-89 million persons clinically ill
• 18-42 million persons require outpatient care
• 314,00-733,000 persons hospitalized
• 89,000-207,000 deaths
• Economic cost estimated at 71-166 billion

42
Pandemic Influenza Potential Impact of Pandemic
Influenza in the U.S.

• Vaccine and antiviral drugs will be in short
  supply
• 6-8 month lag-time needed for vaccine
  availability
• Healthcare workers and other first responders
  will be at higher risk of exposure and illness
  than the general population
• Healthcare system will be overwhelmed
• Risk of sudden shortages of key personnel in
  critical community services police, fire,
  power/utilities, transportation, air traffic
  controllers, etc.

43
??ast????t?ta ???p?? st?? ????da???t?? ?d??t??
??at???
44
?a?d?µ?a ???p??-????da?d?? p???ata?t??? e?t?µ?s?
f??t??? ??s???t?ta?
45
?a?d?µ?a ???p??-????da?d?? p???ata?t??? e?t?µ?s?
f??t??? ??s???t?ta?

46
G??p???s???t?ta ?a? ???t?t?ta???a? ? ???p?
??s???µe?a?? ???µ???

• ?at? t?? ep???a??? ep?d?µ???? e???se?? t?? ???p??
  st?? ??? ap? t? 1979-80µ??? t? 2000-1
  ?p?????st??e a?? ep?d?µ?a
• ??s??e?e? ???? ???p??54.000-430.000
• ??s??e?e? ep?p???? s?et???µe?e? µe t?? ???p?
  226.000 (63 se ?t?µa gt 65
  et??)
• ?? ???at?? ?fe????ta? se p??t?pa?? ? de?te??pa??
  p?e?µ???a ?a? se ??a?s? ?a?d??p?e?µ?????? ? ?????
  ??????? ??s??

47
G??p? ?a? ????? pa????? ??e?a?

• ??? ? ??? t?? ???p?? e?sa??e? se ??a ??s???µe??
  ? ???? ???? ?a????? ??e?a? µ?s? µ???sµ????
  p??s?p????, as?e??? ? ep?s?ept?? d?aspe??eta?
  s?et??? ??????a ?a? p???a?e? ??s? ?a? se ??????
  as?e?e?? ?a? e??a??µ?????
• ??s?st? µ????s?? ??? 70 µeta?? t?? as?e??? ?a?
  t?? p??s?p???? ?at? t? d????e?a ep?d?µ??? ???p??
  se ??s???µe?a

48
?ate????t???e? ?d???e? ??a t? d?a?e???s?
????sµ?t?? ep?????? ???p?? st??? ?????? pa?????
??e?a? (www.keel.org.gr)

• ? ??????s? ?a? ? ?p?t??p? ??s???µe?a??? ???µ??e??
  ?ata?t????? s??d?? a?t?µet?p?s?? t?? ep??????
  ??a?s?? t?? ???p?? a??? ?a? s??d?? pa?d?µ?a?
• ???µ???s? ?a? e?pa?de?s? t?? p??s?p????
  (s?µpe???aµßa??µ???? ?a? t?? ß????t????) ??a ta
  µ?t?a p??f??a??? ap? t? µet?d?s? t?? ???p??
• ???a???? a?t????p???? eµß???asµ? ???? t??
  p??s?p???? p?? ???eta? se epaf? µe as?e?e??
• ?? p??s?p??? ?a? t? ep?s?ept???? p??pe? ?a
  ?aµß??e? t?? p??f????e?? µet?d?s??
• ?as????
• Sta????d???
• ?paf??

49
?as??? µ?t?? ???e???? ???s?µ? /a?t?s???a ?e????

• ?a ????a p??pe? ?a p?????ta?
• p??? ?a? µet? t?? epaf? µe as?e??
• ?ta? e??a? eµfa??? ?e??µ??a
• µet? ap? d?ast????t?te? p?? e??a? d??at?? ?a
  p???a??s??? µ????s?
• µet? t?? afa??es? t?? ?a?t???
• ?p??e??? t?? ?e???? µe a?t?s?pt??? p?? ????? ??
  ß?s? t?? a?????? ???eta?
• µet? ap? d?ast????t?te? ?ta? ta ????a de? e??a?
  eµfa??? ?e??µ??a
• µet? t?? afa??es? t?? ?a?t??? µet? t? p??s?µ?
  t?? ?e???? af?? ta ????a ????? ste???se? ? ???s?
  t?? ?a?t??? de? ?p??a??st? t?? ???e??? t?? ?e????

50
???????S ??????S??S ???S??S??S G?? S???T? ???????
G????

• ??s?a a?ap?e?st???? p??stas?a? ap?? ?e?????????
• G??t?a µ?a? ???se?? ta ?p??a a??????? ?at? t?
  d????e?a d?af???? ?e???sµ?? st?? as?e??
• ??d??? p??state?t??? ??a??? e????? ?pt????
  ped??? ? asp?da p??s?p??
• ???state?t??? µp????a µ?a? ???s??

51
?as???? p??f????e?? (standards precautions)
???s? ?a?t???
???e??? ?e????
???s? p??state?t???? ??a????
???s? µ?s?a?
52
???s? µp????a?
53
?????G? ???S???????O? ?ST??O? S?? ??S???????

• St?? e??te???? e?s?d? ???e ??s???µe??? ?p???e? ?
  ????s??? (BOX)
• Sta ??? e?d??? ?a????sµ???? ????? a?aµ???? ?a?
  e??tas??
• ??te
• ?at? t? d????e?a t?? ep?????? ??a?s?? t?? ???p??
  ??t?ß???? -?p??????
• ???
• ???? t?? e?s?d? st? ??? ?a? sta ?a?t??? ???te????
• ?????e?ta? µ?s?a se ?t?µa p?? eµfa?????? ß??a ?
  ?a? ft????sµa
• ? µetaf???a? f??? µ?s?a t?? ?p??a afa??e? aµ?s??
  µ???? ap?µa?????e? ap? t?? as?e??
• ?e? p??s???e? f????ta? t?? ?d?a µ?s?a ?????
  as?e?? ? p??s?p???
• ? as?e??? µetaf??eta? st?? e?d??? ???? a?aµ????

54
???????O??S? ?ST????S ??????? G?? G???? S?? ? ?
????????S???? ????????
1.

• ?f?se? ? ???? ??t?p? ????? µe ßas???? ?d???e?
  a?ap?e?st???? ???e???? ?a? p??????? µet?d?s?? t??
  ???p?? ??a p??se???µe???? as?e?e?? ?a? s???d???
  t??? se eµfa?? s?µe?a st?? e?s?d? t?? ? ?
  ? ?a? st??? ?????? a?aµ????
• ?a?t?µ??t??a (??a ?a ?a ap?fe??e? t?? e?t??a??
  sta????d??? ?a??pt??ta? t? st?µa ?a? t? µ?t? se
  ß??a ? fta???sµat?? )
• ??s?e? (ap??? ?e??????????) ??a ??????s? se
  ?t?µa p?? eµfa?????? ß??a ? ?a? ft????sµa ?s? t?
  d??at?? ta??te?a
• ??t?s?pt??? d?a??µata ??a t?? s???? ???e??? t??
  ?e????
• ?p???e?a ????? sap?????? ?a? ?e???petset?? µ?a?
  ???s?? st??? ??pt??e?
• ??d?????t?? ??d?? ap????µµ?t?? ??a ta µ???sµ??a
  ?a?t?µ??d??a

55
???????O??S? ?ST????S ??????? G?? G???? S?? ? ? ?
1.

• ?s?e?e?? µe s?µpt?µata ap? t? a?ap?e?st??? (ß??a
  ?a? ft????sµa) t?p??et???ta? se
• Se ?d?a?te?? ???? a?aµ????
• ?? de? e??a? d??at??
• ?a ?????ta? se ap?stas? t??????st?? µ?t??? ap?
  ???a ?t?µa
• ?fa?µ??? t?? ?d????? t?? a?ap?e?st????
  ett???ta?

56
??S????? ?ST????S ?? G???? ? ??????? G??
G??????????OS? ?O? ?ST??O?
1.

• 1. ??s??e?a ???e as?e???? se ?d?a?te?? d?µ?t?? a?
  e??a? d??at??
• 2. Se pe??pt?s? µe????? a???µ?? ??s??e??µ????
  a???st?? µe e?de??µe?? ? ep?ßeßa??µ??? ???p?
  µp??e? ?a ???eta? s?????t??s? se ?e????st? tµ?µa
  ? ???aµ? t?? ??s???µe??? (cohorting)
• 3. ?ta? st?? ?d?? ???? ß??s???ta? ?t?µa µe
  ep?ßeßa??µ??? ???p?, e?de??µe?? ?a? µ? µ???sµ??a
  ???e ??eß?t? ap??e? ap? t? ????
• t??????st?? ??a µ?t??
• ??a????st??? ????t??a µeta?? t?? ??eßat???
• 4.?? p??s?p??? e??a? eµß???asµ???
• 5. ?e? as???e?ta? µe t? f???t?da µ? µ???sµ????
  a???st??
• 6. ???f????e?? sta????d??? ?a? epaf?? ep? p????
  ap? t?? ßas????
• 7. ?e?????sµ?? t?? ep?s???e??

57
??S????? ?ST????S ??????? G?? G????
1.

• ???s??? se ?e???sµ??? p?? p???a???? a???µ???
  d?asp??? sta????d??? ?a? ae????µat??
  (?efe??p???t??, ? a?ep?e?st??? f?s???e?ape?a,ß????
  ?s??p?s?, ?ast??s??p?s?,a?a???f?se??, ?
  e?d?t?a?e?a?? d?as?????s? ?.a.)
• ?p?fe????ta? ?? ?s??pe? µeta????se?? t?? as?e????
  
• ap?? µ?s?a p??stas?a? e?? µeta?????e?

58
??S????? ?ST????S ??????? G?? G???? ??????S??S
??? S?S????S
1.

• ????? ??s??e?a? µ?a? ???se?? ?a? ap???e?st????
  ?at????? e??p??sµ?? p ? st???s??p?a pe???e???de?
  s?s?e??? a?a???f?s??
• ????? p???ap??? ???se?? (p?es?µet?a, ?e?µ?µet?a)
  µet? t? p??a? t?? ??s??e?a? t?? as?e????
  ap???µa????ta? µe µet???? ßa?µ?? ap???µa?s?
• ????? ?p?? ???a?t??e?, f???e? a?a???f?s??
  ap???µa????ta? µet? t? p??a? t?? ??s??e?a? µe
  ?????? ßa?µ?? ap???µa?s? µe ap???µa?t??? e?????
  f?sµat?? ? ap?ste??????ta? af?? ??e? p??????e?
  ?a?a??sµ??
• ????? p???ap??? ???se?? p ? ß?????s??p?? p?? µet?
  t? ???s? t??? p??pe? ?a ???s?µ?p??????? se ??????
  as?e?e?? ap???µa????ta? µe ?????? ßa?µ??
  ap???µa?s? µe ap???µa?t??? e????? f?sµat?? 7. , ,
  
• G?a ta µ??a??µata ?a? ta a?t??e?µe?a p?? de?
  µp????? ?a ap???µa????? µe eµß?pt?s? ?
  ap???µa?s? p??pe? ?a ???eta? µe ap???µa?t???
  e????? f?sµat??

59
??S????? ?ST????S ??????? G?? G???? ????????O? ?
???????? ?? S??????S?????S ??T?G?????????S
1.

• ????? ??OS S?? SARS
• ???F??????S ????? ??????OS?O?
• S?????S??S ??S??O? ???F?S
• ????G??O?
• ??????OS?S

60
??S????? ?ST????S ??????? G?? G???? ????????O? ?
???????? ?? S??????S?????S ??T?G?????????S
1.

• M????? ??? ???????? ??? ?? SO?? ?? ???????
  ???S????O?????? ?? S?G???????? ?????? ????????S??
  S?? ?G??
• ????? G?????
• ?????? ??F???S ????????
• ????????? ???? ?OS ??G?????
• ???S???! ??? ?G????? S?? ???????

61
??S????? ?ST????S ??????? G?? G???? ????????O? ?
???????? ?? S??????S?????S ??T?G?????????S
1.

• ????G????S (AIRBORNE) ???F??????S
• ???f???s??? ap? ???µ?d? ??s?µata p??
  µetad?d??ta? µe p????e? sta????d??? p??? µ??????
  (lt5 µ) ?a? d?µ???????? ae????µa
• ??????S ??S??S ?-95 ? ?-99
• S? ??T??????? ??G???S ??T?S? ?????? ???????S????
  S?S???? PAPR (Particulate Air Purifying
  Raspirator)

62
???G??S SOS??S ???S?S ??S ??S??S ??p?? ?-95
63
????? ???????S ???S??S??SG???? ????????O?

• ???s?µ? µp????a µ? d?ape?at? sta ????, d?ape?at?
  st?? a??a

64
??? ??s??e?a?-???s??µ???? t?p??

• ??ap?e?st??? p??stas?a
• S?s?e?? a?ap?e?st??a ?et???? p?es?? µe a?t??a
  ?a? f??t?? (PAPR) µe p??stas?a ????????? p??s?p??
  ?a? f??t?a ?3

65
??S????? ?ST????S ??????? G?? G???? ????????O? ?
???????? ?? S??????S?????S ??T?G?????????S
1.

• ????G????S (AIRBORNE) ???F??????S
• ???f???s??? ap? ???µ?d? ??s?µata p??
  µetad?d??ta? µe p????e? sta????d??? p??? µ??????
  (lt5 µ) ?a? d?µ???????? ae????µa
• ??d???? µ?s?e? t??????st?? ?-95 ? ?-99
• Se pe??pt?s? µe????? ???es?? a?ap?e?st??? s?s?e??
  PAPR (Particulate Air Purifying Raspirator)

66
??S????? ?ST????S ?? G???? ????????O?
67
??S????? ?ST????S ??????? G?? G???? ??????S??S
??? S?S????S
1.